As important as it is to demonstrate the beneficial effect of employer wellness partnerships on hospital revenue, it's equally important to know the minds of employers and make sure they're seeing the benefit of paying good money to a health care organization.

That begins with showing employers that the hospital and its service lines are equipped with the proper "mentality" for wellness goals, says Linda Kuklinski, director of benefits for more than 2,000 employees of Generac Power Systems, most of them based in suburban Milwaukee. The proper mentality extends to advocating for community health improvement while committing to controlling costs, she explains.

On the employer side, there has to be trust that the provider won't run up the tab for covered services. "If I offer preventive care to our employees, that sometimes can open a door — 'Woo hoo, let's do all this stuff because we know they cover that 100 percent.' I know that with the right relationship, I am going to have appropriate and medically necessary health care done," Kuklinski says.

"By entering into these relationships, you're not just entering into a pricing contract, you're entering into a culture contract," she adds. Hospitals "have to be willing to accept and really want to be part of the community advocacy versus just providing medical services" and "driving up the costs of our plan by doing unnecessary things."

Generac's wellness partner, ProHealth Care, Waukesha, Wis., has helped hold down costs per employee to less than 5 percent per year, 31 percent below the national average, despite exponential growth in the workforce from 640 in 2002 — the onset of aggressive programs for wellness — to 1,000 in 2007 and more than 2,000 today. The health system has been "very successful in providing [not only] the health care services, but really expanding the health care environment itself," Kuklinski says.

The role of a local hospital organization in expanding that environment may not be obvious to many employers yet, says Pearson Talbert, president of Aegis Health Group. Typically, people think of a hospital as a place to go when they're very sick, and "they don't think of a hospital as a place for health and wellness. And they need to, because there's a wealth of knowledge there, there's a wealth of technology," Talbert says.

Getting employees to see a doctor regularly, understand their health risks and reduce them over time "can benefit the employer —over time it should lower their costs — and it also keeps their employees healthier, which is good for them besides lowering their costs," says David Ameen, CEO of Logansport (Ind.) Memorial Hospital, which operates an employer wellness program called Centric.

But simple education about how to stay well is paramount, including guidance on things as basic as buying food, says Alan McCloskey, Centric vice president. The program works with nutritionists at Logansport Memorial and at Witham Health Services, a hospital partner in Lebanon, Ind., to put on seminars about healthier eating or even lead trips to grocery stores. For example, employees at a manufacturing firm in Monticello, Ind., pushed back when presented with education on striving for better nutrition. "Healthier food is more expensive," says McCloskey. "So we had a dietician come in, took 20 people shopping and showed them how to do it."

Much of what wellness programs sell to employers is that "you will have a better outcome if you get to that person sooner in life," Talbert says. High costs for, say, coronary care, can be entirely prevented through proper diet, exercise and primary care. But wellness attention heads off costs at any stage of the disease, he emphasizes, by preventing what's even worse. For someone with coronary artery blockage, having to put in a stent is less expensive than bypass surgery; bypass surgery is less expensive than a transplant.

A major message is that employers can do much to tame potentially costly illnesses such as diabetes, "which is not a curable disease, but it's a controllable disease," Ameen says. "And that's why we work with the employers so they understand what these diseases are and what you can and cannot do."

That includes designing the insurance plan as a series of levers and incentives that reward good health. "It's monetary — that's what drives it," Kuklinski says. Participation in the program at Generac is tied to premiums, deductibles and other variables than can be adjusted up or down. For employees who get price breaks, that circles back to their positive steps to maintain health. "What you do and how you act affects your claims," she says.

At San Luis Valley Regional Medical Center, which developed a wellness program for its employees, a set of incentives and disincentives around medical services is aimed at pushing prevention while forcing second thoughts on expensive care without sure benefit, says Russ Johnson, CEO of the Alamosa, Colo., organization.

There is one list of procedural and clinical services labeled "high value, no co-pay" that includes 20 medications provided at no charge to employees. "We're trying to remove every barrier to that employee's taking active engagement in managing preventive and primary care, but also if they're in a chronic condition," which is where cost control needs to start, Johnson says.

Another list, labeled "cost more, learn more," identifies procedures for which the medical evidence of benefit is not clear-cut and alternatives are available. For 26 procedures, employees are charged an additional $300 co-payment separate from other terms of the health plan, including not counting toward the deductible. "It's a way that we say this procedure deserves a little more thoughtful consideration before just moving ahead with it," says Johnson.

Booklets and videos, through a center for informed decision-making at Dartmouth's Hitchcock Medical Center, lay out evidence for various procedures and includes research on relative outcomes — for example, efficacy of such heart-disease options as medical management, angioplasty and coronary bypass surgery with outcomes at one, five and 10 years. "It's very even-handed; it's not trying to steer patients," he says.

These are sophisticated uses of a health plan for promoting health and prodding thoughtful attention to costs, and they still may be a relatively new concept for many employers to grasp.

Ten years ago, when Generac initially rolled out its program with ProHealth Care, it had no preventive services in its plan design, Kuklinski says. "We had a culture at that point where your health insurance is not much different from your auto insurance. You have insurance to cover 'accidents' that happen, but your day-to-day taking care of your tires and putting in gas you don't buy insurance for."

Now the wellness component is so entwined that the health plan includes its own processing system for discounting services provided by ProHealth Care, she says. Generac pays the hospital directly instead of through individual patient accounts, and if there is any employee cost, it's handled through payroll. That's a benefit to the hospital system "because we've eliminated their accounts receivable" for lab charges, $20 co-payments and the like. "It breaks down to one accounts receivable customer vs. 1,200 accounts receivable customers."

For more about hospital-business partnerships, please see "Mutual Benefits".

John Morrissey is a freelance writer in Mount Prospect, Ill.